Delayed Recovery from General Anaesthesia: A Post-operative Diagnostic Dilemma and Implications of ICU Management of Serotonin Toxicity. Case report

Asha Naik; Cristobal Rincon-Aznar

doi:10.1515/jccm-2015-0026

.blurhash-client-img { display: none !important; }

Delayed Recovery from General Anaesthesia: A Post-operative Diagnostic Dilemma and Implications of ICU Management of Serotonin Toxicity. Case report

The Journal of Critical Care Medicine

Volume 1 (2015): Issue 4 (October 2015)

By: Asha Naik and Cristobal Rincon-Aznar

Open Access

|Nov 2015

Abstract

We report a case of delayed recovery from general anesthesia following a routine parathyroidectomy. Our objectives are to describe the process of establishing a differential diagnosis and subsequent management of a patient presenting with atypical neurological signs from an unknown etiology and to increase awareness about the potential for serotonin syndrome and neurotoxicity due to known interactions between methylene blue and selective serotoninnoradrenaline re-uptake inhibitors. ICU management of Serotonin Toxicity is briefly described.

References

1. Kuriloff DB, Sanborn KV. Rapid intraoperative localization of parathyroid glands using methylene blue infusion. Otolaryngology- Head Neck Surgery. 2004;131:616-22.10.1016/j.otohns.2004.04.02615523436
Search in Google Scholar
2. Patel HP, Chadwick DR, Harrison BJ, Balasubramanian SP. Systematic review of intravenous methylene blue in parathyroid surgery. Br J Surg. 2012;99:1345-52.10.1002/bjs.881422961511
Search in Google Scholar
3. Ramsay RR, Dunford C, Gilman PK. Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO A) confirms a theoretical prediction. Br J Pharmacol. 2007;152:946-51.10.1038/sj.bjp.0707430207822517721552
Search in Google Scholar
4. Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic rules for serotonin toxicity. QJM. 2003;96:635.10.1093/qjmed/hcg10912925718
Search in Google Scholar
5. Mowry JB, Spyker DA, Cantilena LR Jr, Bailey JE, Ford M. 2012 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 30th Annual Report. ClinToxicol (Phila). 2013;51:949-1229.10.3109/15563650.2013.86390624359283
Search in Google Scholar
6. Shopes E, Wayne Gerard W, Baughman J. Methylene blue encephalopathy: a case report and review of published cases. AANA Journal. 2013;81:215-21.
Search in Google Scholar
7. Khan MAS, North AP, Chadwick DR. Prolonged Postoperative Altered Mental Status After Methylene Blue Infusion During Parathyroidectomy: A Case Report and Review of the Literature. Ann R Coll Surg Engl. 2007;89:W9-W11.10.1308/147870807X160434196458617346391
Search in Google Scholar
8. Johnson N, Soar J, Robinson S. Concurrent administration of methylene blue and a selective serotonin reuptake inhibitor: a recipe for serotonin syndrome. Journal of the Intensive Care Society. 2012;13:256-8.10.1177/175114371201300318
Search in Google Scholar
9. Khavandi A, Whitaker J, Gonna H. Serotonin toxicity precipitated by concomitant use of citalopram and methylene blue. Med J Aust. 2008;189:534-5.10.5694/j.1326-5377.2008.tb02168.x18976207
Search in Google Scholar
10. Ng BKW, Cameron AJD. Serotonin syndrome following methylene blue infusion during parathyroidectomy: a case report and literature review. Can J Anaesthesiol. 2008;55:1-5.
Search in Google Scholar
11. Martindale SJ, Stedeford JC. Neurological sequelae following methylene blue injection for parathyroidectomy. Anaesthesia. 2003;58:1041-2.10.1046/j.1365-2044.2003.03415_23.x12969068
Search in Google Scholar
12. Isbister GK, Buckley NA, Whyte IM. Serotonin toxicity: a practical approach to diagnosis and treatment . Med J Aust. 2007;187:361-5.10.5694/j.1326-5377.2007.tb01282.x17874986
Search in Google Scholar
13. MHRA Drug Safety Update. 2009, vol 2 issue 9:3.
Search in Google Scholar
14. Methylene blue: Drug Safety Communication - Serious CNS Reactions possible when given to patients taking certain psychiatric medication. July 2011 (updated October 2011)
Search in Google Scholar
15. Lead Directorate: Marketed Health Product Directorate. Methylene blue injectable in combination with serotonin reuptake inhibitors - Association with serotonin toxicity - Notice to Hospitals. 2011. Available at: http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2011/14648a-eng.php
Search in Google Scholar
16. Hall M, Buckley N. Serotonin syndrome. Australian Prescriber. 2003;26:62-3.10.18773/austprescr.2003.044
Search in Google Scholar

Articles in this issue

DOI: https://doi.org/10.1515/jccm-2015-0026 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809

Journal RSS Feed

Language: English

Page range: 174 - 178

Submitted on: Jun 4, 2015

Accepted on: Sep 16, 2015

Published on: Nov 10, 2015

Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

Related subjects:

Internal medicine, other,

Surgery,

Surgery, other,

Anaesthesiology,

Emergency medicine and intensive-care medicine

© 2015 Asha Naik, Cristobal Rincon-Aznar, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 1 (2015): Issue 4 (October 2015)